Economic analysis of out-of-pocket costs among people in opioid agonist treatment: A cross-sectional survey in three Australian jurisdictions

Anh Dam Tran; Rory Chen; Suzanne Nielsen; Emma Zahra; Louisa Degenhardt; Thomas Santo Jr; Michael Farrell; Briony Larance

doi:10.1016/j.drugpo.2021.103472

Economic analysis of out-of-pocket costs among people in opioid agonist treatment: A cross-sectional survey in three Australian jurisdictions

Int J Drug Policy. 2022 Jan:99:103472. doi: 10.1016/j.drugpo.2021.103472. Epub 2021 Oct 11.

Authors

Anh Dam Tran¹, Rory Chen², Suzanne Nielsen³, Emma Zahra², Louisa Degenhardt², Thomas Santo Jr², Michael Farrell², Briony Larance⁴

Affiliations

¹ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. Electronic address: anh.tran@unsw.edu.au.
² National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
³ Monash Addiction Research Centre, Monash University, Melbourne, Australia.
⁴ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; School of Psychology, University of Wollongong, Wollongong, Australia; Illawarra Health and Medical Research Institute University of Wollongong, Wollongong, Australia.

PMID: 34649203
DOI: 10.1016/j.drugpo.2021.103472

Abstract

Background: Out-of-pocket costs for opioid agonist treatment (OAT) constitute a barrier to treatment entry and retention.This study examines OAT clients' total out-of-pocket costs (including dispensing fees, travel costs and OAT-related appointment costs) in different treatment settings (public clinics, community pharmacies, and private clinics).

Methods: Cross-sectional survey of 402 people with opioid drug use (OUD) in New South Wales (NSW), Victoria (VIC), Tasmania (TAS), Australia; 266 clients (66%) currently receiving methadone, buprenorphine or buprenorphine-naloxone treatment were asked about dispensing fees, travel costs and OAT-related appointment costs in the past 28 days. A two-part regression model was used to deal with non-normal distributions of costing data (right skew and excess zeros).

Results: Among clients currently receiving OAT, 87% paid out-of-pocket costs. Among those who paid out-of-pocket costs (N=194), travel costs accounted for more than half of total costs (52%), followed by dispensing fees (44%). The mean monthly total out-of-pocket costs were AU$135 (SD: AU$121) for public clinics, AU$161 (SD: AU$110) to AU$214 (SD: AU$166) for community pharmacies and AU$355 (SD: AU$159) for private clinics. Compared to participants in NSW private clinics, those at public clinics paid one third the total out-of-pocket costs (coefficient = 0.33; 95%CI = 0.23-0.48) and those at NSW, TAS, VIC pharmacies paid approximately half the costs (coefficient = 0.58; 95%CI = 0.42-0.79; coefficient = 0.51; 95%CI = 0.36-0.72; coefficient = 0.47; 95%CI = 0.34-0.66, respectively). People in OAT for more than a year paid half the total out-of-pocket costs, compared with those in OAT less than a year (coefficient = 0.49, 95%CI = 0.31-0.77).

Conclusions: Participants in the current study spent one-eighth of their income on out-of-pocket costs associated with OAT representing a substantial financial burden. Total out-of-pocket costs disproportionately affects those who are newer in treatment and receiving fewer unsupervised doses. Considering and addressing total out-of-pocket costs, especially travel costs and dispensing fees, to clients is critical to prevent cost from being a barrier from receiving effective care.

Keywords: Clinic; Dispensing fees; Opioid agonist treatment; Out-of-pocket costs.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Analgesics, Opioid / therapeutic use
Buprenorphine* / therapeutic use
Cross-Sectional Studies
Health Expenditures
Humans
Methadone / therapeutic use
Opiate Substitution Treatment
Opioid-Related Disorders* / drug therapy
Victoria

Substances

Analgesics, Opioid
Buprenorphine
Methadone